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Clinical Challenges of Rehabilitation in Periodontal Disease

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Most patients affected by periodontal disease ask about the treatment options alternative to bone grafts or extractions. Read the article to know more.

Medically reviewed by

Dr. Sowmiya D

Published At May 23, 2022
Reviewed AtAugust 2, 2023

Why Is Prosthetic Rehabilitation Challenging?

The most clinically challenging phase of the dental implant surgeon or the prosthodontist is to restore the form, function, and esthetics in a periodontally compromised patient. In patients suffering from periodontal diseases, the dentition may be severely affected or significantly weakened due to underlying bone loss when left untreated by the dentist for a long time.

The current advanced implant therapy is also a limitation for severely compromised periodontal patients. In periodontal disease, there is a significant loss of bone volumes that need substitution or regrowth to enhance the phenomenon of osseointegration, be it in partially edentulous or completely edentulous patients.

Osseointegration of implants or the prosthetic rehabilitation of missing teeth with crown or bridge poses a problem owing to the loss of bone volume due to periodontal disease. The dentist hence frequently adopts a conservative strategy for most patients who refuse full mouth rehabilitation by attempting to maintain as many natural teeth as possible after periodontal gum surgery and treatment.

What Are the Types of Implant Prosthesis Used in Periodontally Compromised Patients?

There are mainly two types of prosthesis that support dental implants in partially or completely edentulous patients suffering from periodontal disease. These include:

  • TRP (telescopic retained retrievable prosthesis).

  • FP (full arch fixed prosthesis).

The implantologist can implement this prosthetic rehabilitation after one clinical session of ATP or active periodontal therapy. ATP can be adopted as a therapeutic or surgical treatment strategy for those patients who refuse either because of economy or fear of safety, or dental phobias to procedures like complex bone grafts or sinus augmentation procedures.

What Is Active Periodontal Therapy (APT)?

Active periodontal therapy or APT mainly involves the periodontist or the maxillofacial surgeon adopting a series of procedures to aid bone regeneration and growth to compensate for the volume loss due to disease. The dental surgeon throughout performs periodontal assessment, and then if needed, flap surgery can be achieved.

An essential step before implementing active periodontal therapy is the assessment of furcation involvement of the teeth. The dentist would mainly diagnose furcation involvement on clinical probing, and debridement surgeries can be performed in the furcation area with the help of certain diamond-coated sonic scalers during the flap surgery.

Other accessory procedures like pocket elimination surgery, regeneration procedures, bone grafts, and osseous resection are all only additionally attempted if absolutely indicated in the periodontally compromised patient.

What Is Splinting and Supportive Periodontal Therapy?

The choice to extract severely compromised remaining teeth in a partially edentulous patient depends upon the dentist alone after active periodontal therapy. Supposing the teeth in question have a hopeless prognosis. It is indeed unpredictable, as even after the initial phase of periodontal treatment, the teeth have failed to respond to periodontal surgical therapy in such cases. Also, if periodontitis is eliminated or at least prevented from reoccurrence for some time, then full-arch fixed bridges are a good option recommended by the dentist, prosthodontist, or implantologist to successfully maintain the fixed bridges on a minimal number of abutment teeth.

Periodontally affected teeth that have responded to treatment in terms of tooth health but still have not regained any gingival or bone support and remain mobile can be splinted to retain them as abutments for the fixed bridge prosthesis. However, the question of the lifespan of such mobile teeth affected by weak periodontal support is always in doubt despite rigorous oral hygiene and frequent dental checkups. This is because the bone support is severely impacted, which has caused tooth mobility.

Still, evidence shows that such splinted teeth can also last with a 90 % survival rate, especially if the patient maintains good oral hygiene and follow-up dental visits that assure long-term prosthetic success. Splinting, however, is only a final option, according to the prosthetic surgeon, as it is mainly to enhance patient comfort. SPT or supportive periodontal therapy by the dentist is a significant factor that shows substantial improvement in the long-term success rates of the implant or crown and bridge prosthesis.

For Whom Is a Dental Implant Prosthesis Unsuitable?

With regular supportive periodontal therapy, evidence shows that bone loss can be significantly prevented even after the prosthetic rehabilitation of the patient in the long term. Furthermore, the all-on-four concept of implant rehabilitation is also an advanced strategic modality that helps replace all the periodontally compromised teeth with a hopeless prognosis. This is done by extracting all the remaining teeth in the patient and then replacing them with dental implants using the novel "all-on-four" concept.

Dental literature shows that this prosthetic implant strategy works with a 99.8 % survival rate for more than 24 months in patients who are ideal for dental implantation, which again depends on the factors like age of the individual, the bone volume, the bone density, and the period of edentulism or periodontal disease. Implant strategies may not work favorably in patients with altered immune responses, cellular stress, or immunocompromised bone healing (as in various general systemic conditions, syndromes, disorders, or STDs).

Hence proper, timely assessment by the prosthodontist or the implantologist for tooth replacement or for adopting active and supportive periodontal therapies before prosthetic rehabilitation treatment will prove highly productive in successful long-term outcomes.

Conclusion:

To conclude, prosthetic rehabilitation be it by an implant or fixed prosthesis, is a clinically challenging phenomenon for the dentist that requires careful assessment of periodontal parameters, the prognosis of the teeth in question, patient cost factors, risk of complications, and patient's expectations of comfort and convenience. Hence, active periodontal therapy before rehabilitation and supportive periodontal therapy after rehabilitation will help long-term prosthetic success in periodontally compromised patients.

Frequently Asked Questions

1.

What Are the Challenges in Rehabilitation in Periodontal Disease?

The most commonly faced challenge in rehabilitating periodontal disease is to restore form, function, and esthetics. Patient satisfaction is yet another challenge. The dentition in a periodontal-challenged patient is very weak, and hence restoring it to the prior state is very challenging.

2.

What Is the Most Difficult Part of the Rehabilitation Process for Periodontal Disease?

Restoring the function and esthetics in a periodontally weak patient is the most difficult part of the rehabilitation process. Since the dentition is very weak, restoring it back can be a tedious and challenging process. The presence of comorbidities makes it even more difficult.

3.

What Is Rehabilitation of the Physically Challenged?

Rehabilitation of the physically challenged includes steps taken to improve the quality of life of the physically challenged people, to optimize functioning. This also helps them to interact with their environment better and makes life easier for them.

4.

What Are the Three Types of Rehabilitation?

The types of rehabilitation include:
 - Preventive rehabilitation includes patient education, advising, and intervention to prevent further deterioration of the condition.
 - Restorative rehabilitation includes interventions to improve the impairments and to function better.
 - Supportive rehabilitation helps to help the patient to do things on their own.
 - Palliative rehabilitation, helps to reduce pain and leads to a better quality of life.

5.

What Are the Four Barriers to Rehabilitation?

The barriers to rehabilitation can include logistic factors like distance to the service center, difficulty in transportation, affordability factors like the cost of the treatment, lack of insurance, and attitude of the patient. The patient may also reject the need for rehabilitation unless it begins to affect their daily life.

6.

What Are the Main Objectives of Rehabilitation?

The main objective of rehabilitation is to make the patient able to live a better quality of life and to be as independent as possible. This helps them to be more productive in life, and also helps them in education and better interaction with the world.

7.

What Are the Negative Effects of Rehabilitation?

In drug rehabilitation, the patient may show withdrawal symptoms that can have negative effects, or even destroy their life. Constant monitoring of such patients is required. Other negative impacts can include the deterioration of health if rehabilitation is stopped midway. This can be associated with the attitude of the patient, the cost of the treatment, etc.

8.

What Is the Main Component of Rehabilitation?

Peer or family support, advice, physical exercise, use of technology to help the process, and the attitude of the patient are thought to be the components of rehabilitation. Support from the family or peers can play a very important role in helping the patient to recover. With supportive partners, the patient can at least give it a try in the process, though they are unwilling.

9.

What Is the Range and Scope of Rehabilitation?

Rehabilitation offers a wide range of services. These can range from helping the patients to learn basic communication skills to complex neurological rehabilitation following an accident or stroke. The help or scope of rehabilitation is much more evident as the patient begins to lead a better quality of life and be more productive in spite of their disabilities.

10.

What Is the Root of Rehabilitation?

The root or core goal of rehabilitation is to help the patient live a better life by overcoming their disability. This helps them to live a more productive life with better living conditions. Rehabilitation also helps to prevent further progression of the pre-existing damage.

11.

Does Rehabilitation Begin by Preventing Complications?

Rehabilitation deals with preventing, minimizing, or managing the complications associated with ill health. The first step of rehabilitation is usually recovery. This can be the most important stage. Its duration can depend on the severity of the injury or disability.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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